Gathering the Patient’s Story and Clinical Empathy

Halpern, J. (2012). Gathering the patient’s story and clinical empathy. The Permanente Journal. Winter 2012 - Volume 16 Number 1.

Excerpt: While nothing replaces meeting with a patient, reading another physician’s description of interviewing a patient can provide insights into physician-patient interactions that we cannot get when we ourselves are involved. In my view, “A Case of Baffling Fatigue with a Spectral Twist” illustrates clinical empathy in action. Often confused with compassion, sympathy, and other benevolent emotions, clinical empathy involves emotional resonance, but is distinguished by curiosity. Whereas sympathy involves feeling as if one were “in the same boat” with another, empathy involves curiosity about another’s distinct experience. Vividly and specifically imagining another’s distinct world becomes possible with careful, attuned listening.

Until the past two decades, physicians (unlike other caregivers) have been skeptical about empathy, assuming that it would interfere with their clinical objectivity and effectiveness. This has shifted as research has shown that empathy plays a fundamental role in both diagnostic accuracy and treatment effectiveness. Repeated studies show that patients first give superficial clues about their histories until they sense empathy, and only then disclose anxiety-provoking information (as happened in the reported case).  Such disclosure is crucial for making the correct diagnosis. Empathy is also important for establishing trust, and trust is a powerful determinant of adherence to treatment and thus effectiveness of care.  Even when clinicians need to deliver bad news, their empathic engagement matters, empowering patients to take earlier steps in organizing treatment and self-care.

Clinicians today want to provide empathic care, but are unsure of just what actions they are supposed to incorporate into their daily practice. Since we cannot just will ourselves to feel certain emotions, what needs to be taught are specific skills or approaches that engender empathy. One of the best studies thus far suggests that one way to “practice” empathy is to learn to help patients tell their stories, exactly as Kate Scannell, MD, does here.  However, readers may wonder how Dr Scannell connects so well with this patient, enabling him to share his story. What specific skills or lessons can we glean from Dr Scannell’s approach?

First, she is genuinely curious about the patient. This requires tolerating uncertainty, so that when the data points don’t connect, Dr Scannell is intrigued rather than frustrated. Further, rather than defensively presuming that the patient is either “a poor historian” or worse, covering up or faking something, she assumes that “we physicians [are] inaccurately pinpointing the patient’s story.” So she meets the patient with empathic curiosity rather than suspicion.

Read the article.


Photo courtesy of Jodi Haplern.

(Something interesting I found)Posted:Nov 01 2012, 12:00 AM by brendah
  • DanRosenblum said:

    After 30 years of practice and writing a book about listening to patients, being variously characterized as full of empathy and devoid of it, a good listener and a bad one, I wonder if what I think of as empathy, the ability to suspend self concern and focus on concern for another, is a voluntary act.  Perhaps it is rather a state of becoming the kind of doctor your patient would most like you to be.  Astute, concerned, involved, and focused solely on her/him.  If so, it is no wonder that the successful empathizes are not always so.

    December 27, 2012 8:27 PM
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